In an opinion piece for the New York Times, Tuteur argues that home births in the U.S. are actually dangerous. Tuteur cites data from Oregon that found the death rate for babies in planned home births with a midwife was about seven times that of births that occurred at a hospital. She also points to research that shows that planned home births with a midwife have a perinatal death rate (the death rate of babies in their final weeks in the womb and first week outside of it) that is triple that of babies born in hospitals.

One issue, Tuteur says, is that there are two types of midwives in the U.S.: certified nurse midwives, whose training includes a college degree in midwifery and extensive hospital training, and lay midwives, aka certified professional midwives, a title a midwife can receive through online training and an apprenticeship.

Research has shown that home births inherently come with some risk; a study published in The Journal of Perinatology found that home births attended by nurse midwives had double the neonatal mortality rate as hospital births attended by nurse midwives. But comparing home births by the two types of midwives, the mortality rate for those attended by lay midwives was nearly double.

Experts say Tutuer is right—and the problem is largely due to complications that can arise during any childbirth.

“If somebody wants a home birth, they need to be very carefully evaluated to make sure they’re low risk,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine tells SELF. “But low risk can turn to high risk very quickly.”

Certified nurse midwives can make a fast “transfer” if something goes wrong during a birth—sending a patient to an ER under the care of an ob/gyn—while certified professional midwives don’t have those connections. Streicher calls certified professional midwives “dangerous,” adding that they often “know nothing.” “They often have the same mode of expertise as the cab driver who helps when a baby pops out on the way to the hospital,” she says.

John C. Jennings, M.D., a past president of the American College of Obstetricians and Gynecologists (ACOG) agrees that unforeseen complications are the biggest risk. “Home births don’t always go as planned,” he tells SELF. “Planned home birth is associated with increased risk of neonatal death when compared with planned hospital birth.”

Risks increase with women who have certain medical conditions like hypertension, a breech baby (when the head is pointing up instead of down), or previous C-section deliveries, he says, but things can also go wrong in the moment.

“I can’t tell you how many women start laboring at home and find out hours into it that the baby is breech,” Streicher says. She also lists maternal seizures, hemorrhaging, and pulmonary embolisms among the “nine gazillion things that can go wrong,” as well as a baby that stops breathing or has a heart rate that plunges. “There’s no end,” she says. “Do things usually go right? Yes, but when they go wrong, they go wrong very fast.”

Carol Hirschfield, a certified nurse midwife with Northwestern Medicine, tells SELF that there are “definitely good candidates” for home births, but they’re low-risk women who don’t have any outstanding health issues.

Of course, a hospital birth isn’t for everyone and birthing centers are increasingly gaining in popularity. How do they stack up in terms of safety? Hirschfield says it depends. “I’m a hospital midwife and I like the comfort of the hospital—I can make a C-section happen in just a few minutes if it’s needed,” she says. “If something happens really urgently at home or a birthing center, a woman would need to be transported to a hospital first.”

Luckily, Hirschfield says there’s often legislation that dictates how far a birthing center can be from a hospital.

Streicher calls birthing centers a “nice balance between hospitals and home births,” noting that if a woman has a certified nurse midwife attending the birth at a birthing center with backup, she should be just fine. ACOG also states that hospitals and birthing centers are the safest place for labor and delivery, Jennings notes.

The choice is ultimately up to the woman, but experts stress the importance of knowing your risk level and being under the care of a good practitioner if you choose to do a home birth. “It really depends on a woman’s desire and her risk factor,” Hirschfield says. “I don’t necessarily think it’s better to go to a hospital—bad things can happen there, too—but it’s important to make an informed decision.”